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Will temporary phone-consult billing codes ever be made permanent?

At the beginning of October, in recognition of the strain that this fall's return of the H1N1 flu would put on its physicians, British Columbia offered the medical community a gift: PG13705. That's the billing code that pays doctors $14.74 for dispensing advice on the pandemic flu to their patients via telephone.

The fee has proven popular. In the first month it was made available to doctors, the provincial insurance plan paid 16,785 claims for PG13705. That's a quarter of a million dollars for that billing code alone, and that was largely before the H1N1 flu really came surging back around the beginning of November.

But just as the government giveth, the government can taketh away. When it's decided it's no longer needed to support doctors dealing with flu patients, PG13705 will disappear "at the declaration of the Provincial Health Officer."

I asked Dr Bonnie Henry, the BC Centre for Disease Control’s director of Public Health Emergency Management, about health administrators' take on the future of paid phone consults. She was one of the people who recommended the creation of PG13705, and although she wasn't ready to recommend that phone consults become permanent features of the billing structure, she didn't rule out the idea. My interview with her appeared in the November issue of Parkhurst Exchange magazine.

PARKHURST EXCHANGE: Logic would say that if having a billing code for phone consults works during a pandemic to deal with people coming in with infectious diseases, wouldn’t it also work not during a pandemic?
BONNIE HENRY: Maybe. [Laughs] I don’t know about that. We would have to look at it how it would be used. But I do think for getting through this it’s a very important piece to help us manage this without putting clinicians at risk.
PE: I ask because I think many physicians would like to have the option to bill for phone calls occasionally.
BH: Yeah, and we do so much by phone we don’t get paid for. Look at lawyers, for example. Talk to your lawyer for ten minutes on the phone and you get billed for it. [Laughs] But, you know, part of it is built into other fee codes. I think there’s a lot of potential for abuse, but clinicians are professionals and should be trusted to use things appropriately. I’m a little on the fence. I do know that this time I was one of the people that advocated for this because we know there are going to be a lot more people infected than usual with influenza this year, and this is one really important strategy to help clinicians be able to cope with that and to help protect our communities.
Ontario followed suit at the end of last month, creating three new fee codes for phone consults: K080, K081 and K082. K080 refers to health-advice calls of 10 minutes or less, and pays $11.00. K081 refers to health-advice calls of longer durations, or to mental health consults of 10-16 minutes, and pays $27.55. K082 refers to half-hour mental health consults, and pays $55.05 per half hour.

One thing that distinguishes the Ontario fee codes from BC's PG13705 is that the Ontario codes aren't restricted to use for H1N1 flu patients, which gives doctors more flexibility in deciding how to run their practice. For instance, a family physician whose waiting room is teeming with suspected influenza cases might decide it's safer to speak to non-urgent flu-free patients by phone, if their care can be reasonably delivered that way. In a statement on November 2, OMA President Dr Suzanne Strasberg explained that the new codes are "designed to alleviate some of the pressures on the health care system. The intent is for doctors to confer with patients over the phone thereby reducing the contact between patients who have the flu and those who do not, while still being able to speak with their doctor about other health concerns."

Ontario physicians were also able to bill for phone consults during the 2003 Toronto SARS outbreak. At the moment, the Ontario Medical Association's current contract with the provincial government doesn't include any permanent fee codes for phone consults, and the mandate for the next set of negotiations hasn't been established yet. K080, K081 and K082 are all temporary codes, like BC's PG13705, and will expire either at the Minister of Health's discretion or after twelve months.

The British Columbia Medical Association begins negotiations in a few months on a collective agreement to replace the current one, which expires March 31, 2012. Although the union and other physicians' groups have asked the government for a permanent phone-consult billing code in the past, Canadian Medicine is told that, at the moment, the BCMA's tariff committee has "no plans at this time to do that" in its upcoming negotiations.

Is there are any chance one or more of the provincial governments might see how useful the phone consults are proving to be and decide to keep them permanently in a limited capacity -- perhaps similar to the current usage, in which the consults will only be compensated when there's a safety reason not to bring a patient into your office?

That remains to be seen.

UPDATE, Dec. 2: Canadian Medicine neglected to mention that Alberta also introduced a special H1N1-flu-related phone-consult billing code this fall, on October 30. Theirs is numbered 03.01AD and pays $20. More information on the Alberta fee code is available here.

Photo: Shutterstock

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8 comments:

  1. sharon2 December, 2009 10:20 AM

    SWOT( strengths,weaknesses,opportunities,threats)

    RE: Telephone service input

    (Weakness)

    In the past office overload has been managed to some degree through patient interraction with ancillary staff where urgency and appointments are decided by telephone.

    This is part of their job description and they are not " paid per call"... in fact their physician employer would be outraged if they suggested it.

    (Threat)

    The physician could assume that role for extra money but then he/she must be prepared for a new category of litigation.

    RE: telephony service input

    (Strength)

    Internet "telephony" is the way of the future where the Assessment step in the decision-making process can include "objective" information....not just the "subjective" revelation of the patient.

    (Opportunity)

    Creative communicator devices could enable many to provide "diagnostic proofs"for certain medical conditions ( e.g. diabetics, vital signs, visuals).

    (Weakness)

    The "payor" giving $ simply by tracking the "event" without assessing the " quality of the event " could result in delayed appropriate treatment interventions and more costly care services later.
    This "telephone" attachment to the patient could cause the equivalent of "rural nursing theory" ....where it is commonly known that this category of patient does not seek medical helps in a timely manner..and are often only physically seen in late stage of disease.
    ["Alternatives" should not receive the same $ value as providing "Equivalents" ]

    (Opportunity)

    If it used more broadly ( versus ad hoc)it would be wise to place some "cap and trade" advantage to it where the service is linked to an identified "social/humanitarian" benefit in providing serivce in areas that have access ( geographic) underservice.

    Delete
  2. Sam Solomon2 December, 2009 10:31 AM

    It's certainly true there are potential downsides to phone consults -- liability among them -- but the Canadian Medical Protective Association and other physician groups have mostly managed to figure out how to resolve the legal questions when it comes to long-distance telemedicine in rural areas, so it stands to reason that other phone consults should be no more of a problem with regards to liability.

    Delete
  3. sharon2 December, 2009 10:40 AM

    RE:
    Impact of Medicine 2.0 perspectives on "distance diagnostics"( e.g. by telephone(y) )

    In this cocktail of collaboration, openness, and apomediation you have a touch of the " Molotov"...if the patient does not have your knowledgeable assessment

    RE: Collaboration

    Collaboration is "inter" professional ( not " intra") and you might not be comfortable with team members the patient has selected for their treatment regime.
    In fact the selection may require you to be more medically vigilant than ever ( if you follow the collaborative mandate to have (PCP) patient-centred practice).

    RE:Openness

    This requires an entirely new construct of what that means between patient and physician...not just between professionals

    RE: Apomediation

    Remember medical school where you had the symptoms of every disease state you were studying?

    The access to the "stand by" world of the internet places that same internet " backyard fence" level of diagnostics " in the middle" of any discussion with the patient who comes to you " pre-diagnosed" by him/herself.

    [Apomediation is only as valuable as the interpretive capacity of both the source and the seeker. In some respects it births an entirely new type of hypochondriacal illness]

    Delete
  4. sharon2 December, 2009 11:00 AM

    "en garde", Sam.. ;)

    Demonstrating " due diligence" is only as valuable and relevant as the "current practice standard".

    In a world of enforceable contracts the "ex" and "im"plicit understandings of the patient must now include "venue" for consult .

    The payors must also determine the " value of providing an "alternative" level.
    [No long distance option could be viewed as "equivalent" to one-to-one personal assessment.." arcus senilis" anyone? ].

    At the same time no one should ever overlook McLuhan's insights on how the "media" is the message NOR the impact of his "tetrad" when applying anything at the level of "innovation"
    ( the worst being " what is the " flip" where you get the exact opposite of what you planned)

    Hence, the new thrust to value " ingenuity" ( versus innovation) as adding value to the chain must not be tainted with "engenuous" inputs....or "disingenuous" motive.

    Delete
  5. sharon2 December, 2009 11:25 AM

    P.S. to Sam

    Few people pick up on the HUGE implied value of even one "word".

    e.g. "engenuous"

    This refers to a type of software that can track and monitor one-to-one inputs for office tracking and datamining.

    [You pick up this "value of each word" skill through dissecting collective agreements ;) ]

    RE: what could be the "flip"

    working from home...or the cottage...or the golf course......is seductive

    BUT

    what if lower rates became the standard (through demonstrated usage) of a methodology?

    what if the physician/client loyalty bond was broken?

    could the "flip" be a breakdown of the "group" in terms of colleague contact and client contact?


    'Distanc(ing) makes the heart grow fonder'...... for somebody else :(

    Delete
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  8. giay nam5 March, 2012 2:59 AM

    Each province’s health insurance billing system is different, but they all have one important thing in common: a gigantic, complex raft of billing codes which are seemingly designed to haunt you in your sleep. With thousands of codes, and with frequent revisions to the fee schedule, it’s difficult to imagine a bureaucratic system (besides perhaps the Canada Revenue Agency’s) more challenging to decipher than your province’s billing agency.Not that it’s your fault. Physicians aren’t being educated on the issue, says Carmen Medeiros of the management and collection firm Ontario Medical Billing Services Inc.

    Delete